title: High-intensity emergency department visits increased in California, 2002-09.
abstract: Increasing use of the emergency department (ED) is well documented, but little is known about the type and severity of ED visits or their distribution across safety-net and non-safety-net hospitals. We examined the rates of high-intensity ED visits--characterized by their use of advanced imaging, consultations with specialists, the evaluation of multiple systems, and highly complex medical decision making--by patients with a severe, potentially life-threatening illness in California from 2002 through 2009. Total annual ED visits increased by 25 percent, from 9.0 million to 11.3 million, but high-intensity ED visits nearly doubled, increasing 87 percent from 778,000 to 1.5 million per year. The percentage of ED visits with high-intensity care increased from 9 percent to 13 percent (a relative increase of 44 percent). Annual ED admissions increased by 39 percent overall; most of this increase was attributable to high-intensity ED admissions, which increased by 88 percent. Safety-net EDs experienced an increase in high-intensity visits of 157 percent, compared to an increase of 61 percent at non-safety-net EDs. These findings suggest a trend toward intensification of ED care, particularly at safety-net hospitals, whose patients may have limited access to care outside the ED.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Herring
authors.forename: Brian
authors.initials: B
authors.lastname: Johnson
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Lin
authors.initials: L
authors.lastname: Feng
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Alter
authors.forename: Renee
authors.initials: R
authors.lastname: Hsia
mesh_terms: D000368:Aged; D002140:California; D059019:Clinical Coding; D016638:Critical Illness / Q000145:classification*; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Access To Care; Disparities; Health Reform; Organization And Delivery Of Care